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The color of care

Allen Temple Baptist Church is buzzing with chatter and upbeat music. On this warm Saturday morning in East Oakland, the church is hosting its annual holistic health fair.

Students from the nursing program at Oakland's Samuel Merritt University, are dressed in blue scrubs, hustling to give eye exams and check blood pressure.

A couple tables down, Samuel Merritt's chief diversity officer, Shirley Strong, hopes to talk with prospective students. The private university has one of the three biggest nursing programs in California, and is committed to reducing health disparities by recruiting more students of color.

"The work of diversity at Samuel Merritt involves recruiting faculty, staff and students of color particularly," Strong says, "especially "African-American/black and Latino/Hispanic students, because they're the ones underrepresented in our community."

Last May, Samuel Merritt University's nursing program graduated its second-largest class of African-American and Latino students — 10 African-Americans and 28 Latinos.

"What we'd like to do is train more [registered nurses] and more case managers and more nurse practitioners," Strong says. "People who are really in decision-making roles in hospitals."

Black and Latino registered nurses needed

The majority of the state's registered nurses are white or Asian-American. While 39 percent of California's population is Latino, just 8 percent of the state's nurses are. Six percent of the state's population is black, but just 4 percent of nurses are.

"Clearly we are lacking African-American and Latina nurses," says David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at UCLA's medical school. Having nurses who more closely represent the state's diversity will "make for better patient care [and] better language communication," he says. Studies show that many Latinos in California lack access to preventive care, and African-Americans experience higher rates of heart disease and shorter life expectancy than whites.

These disparities are what motivated Samuel Merritt grad Shanda Williams to become a registered nurse.

Williams grew up in Oakland, where there's a great need, she says, for providers who understand the community. She's seen this firsthand.

"I would go to the doctor's office with my grandmother," Williams says, "and she would basically lie to all of her doctors about everything that she was doing."

Williams says her grandmother told the doctor she was eating fruits and vegetables and cutting out fried foods. Williams knew that wasn't true.

"It sparked a conversation," she says. But her grandmother dismissed Williams' suggestion that she be more candid with her medical team. " 'They don't understand the way we eat," the older woman told her granddaughter. "This is part of my identity.' "

Williams says this moment stuck with her. The doctor had neglected some key questions.

"There was never really a time when her doctor would ask her ... 'Well, why do you eat that way?' or 'Can we find a compromise?' or anything like that," Williams says. "Those questions never came up."

Helping others achieve

Now Williams wants to extend what she's learned to others. She's a tutor in Samuel Merritt's academic success program, which is specifically geared toward Latino and African-American nursing students. Today she's working with junior Leslie Hernandez. The two sit in one of Samuel Merritt's basement classrooms, going over neuropharmacology.

Hernandez says she sees a lot of Latino classmates in nursing school, but it's not the same when she accompanies family members to the hospital, or when she's out working in the clinic as part of her schooling.

She well remembers the moment she realized the need for more Latino and Spanish-speaking health professionals. She was working in the psychiatric unit of a hospital. Doctors and nurses deemed a particular patient "noncompliant" because she didn't talk.

But Hernandez was able to communicate just fine with the patient — in Spanish.

"She was speaking in Spanish, and she felt like nobody could understand her," Hernandez recounts.

The patient told Hernandez that she had suicidal thoughts, and Hernandez was able to alert the doctor.

Addressing barriers faced by low-income students

Competition for slots in California's public school nursing programs is especially fierce. It can be very hard to get all the classes you need to graduate in four years, and students of color, who may be more likely to have financial pressures to complete school quickly, are underrepresented.

Inadequate financial support is a barrier in other ways, too, Strong says. While lower-income students can take advantage of financial aid to cover tuition at either a public or private school, they are often derailed by other, unexpected expenses.

A sudden need for hundreds of dollars for a car repair or an emergency dental problem, for example, can force students to drop out, Strong says. Many come from families that lack the ready cash to help in an emergency.

To aid these students, Strong says Samuel Merritt is working to create a special fund, "so that when a student has a problem, we just write the check from the emergency fund." That way, he says, students can "stay attentive, and on course to graduate."

Strong says the best preparation for a career in health care starts in high school — or even sooner. "The key really is that they have to take science courses and the math courses early on, so when they get to college they are prepared to step into these various programs," she says.

Students who haven't taken those early preparatory classes spend a lot of time playing catch-up in college, and many find it just too overwhelming to tackle.

Samuel Merritt is partnering with pathway programs such as the Health Academy at Oakland Technical High School, and Berkeley Technology Academy. The goal is to give more students who are interested in the health care field the preparation they need.

California's Board of Registered Nursing forecasts that Latino population growth in the state will continue to outpace the number of Latino registered nurses unless more effort is made to encourage enrollment and graduation of Latinos from RN programs.

While the number of African-American nurses is climbing faster, it's can't happen fast enough for Shanda Williams. She wants to open a clinic with some of her classmates.

"Working in my community is what also helped keep me motivated in school," she says; she thinks other students of color feel the same way, wanting to make positive changes in the towns and neighborhoods they grew up in.Williams wants patients like her grandmother to seek care from people they trust, doctors and nurses who can say, "I'm from the same neighborhood you come from."

This story ran first on KQED's blog State of Health. To see more, visit http://www.kqed.org.